MEDICARE: DR. DONNA L KIESEL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16064	TX

General Provider Information

NPI Number	:	1609902600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA L KIESEL D.D.S.

Provider Business Mailing Address
First Line	:	1703 E BELT LINE RD STE 200
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9606
Country	:	US
Telephone Number	:	372-420-4488
Fax Number	:	469-635-3509

Provider Business Practice Location Address
First Line	:	1703 E BELT LINE RD STE 200
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9606
Country	:	US
Telephone Number	:	372-420-4488
Fax Number	:	469-635-3509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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